The Healthcare Effectiveness Data and Information Set (HEDIS) is a system maintained by the National Committee for Quality Assurance (NCQA) for evaluating the ability of health plans and providers to deliver high-quality care to patients. HEDIS is used by more than 90...
Global Medical Billing Outsourcing Market Analysis 2018-2023
Successful management of medical claims is crucial to improve cash flow and patient satisfaction in any healthcare specialty. An analysis published in Healthcare Finance finds that the average 350-bed hospital misses $22 million in revenue capture opportunities....
How to Report a Separate E/M Service Provided During a Preventive Visit
One E/M documentation challenge that medical coding outsourcing companies face is related to helping physicians report a preventive visit that becomes problem-oriented during the encounter. This is common in the primary care setting, when the patient presents for an...
Challenges Facing Medical Practices in 2018 and How Outsourcing Can Help
Another year has dawned with renewed hope and expectations, but physicians continue to contemplate the many challenges facing them. From EHR data entry, quality measures, and changing reimbursement norms to security issues, consumerism, and burnout, confusion abounds....
How to Improve Revenue Cycle Management in 2018
In this transitional scenario where the industry is moving from fee-for-service to value-based payment, healthcare providers need novel strategies to optimize reimbursement. The following best practices for revenue cycle management (RCM) can improve accuracy and...
Code USPSTF-recommended Preventive Services/Screenings Correctly
The Centers for Disease Control and Prevention (CDC) recognizes that "Focusing on preventing disease and illness before they occur will create healthier homes, workplaces, schools and communities so that people can live long and productive lives and reduce their...
Medicare Looking to Expand Telehealth Services – Learn the Reimbursement Rules
The recent introduction of rare bipartisan legislation to expand Medicare's telehealth services is being hailed as a development that could potentially reduce costs and improve patient health. With an estimated 17.6 million beneficiaries in 2016, physicians and...
Ensure Proper Medical Record Documentation for Risk Adjustment Data Validation (RADV) Compliance
Medicare adjusts payments to Medicare Advantage (MA) organizations for cost variations in providing health care to beneficiaries based on various risk factors, including health status. The goal of risk adjustment is to see that plans are properly reimbursed for the...
Real-Time Electronic Prescription Prior Authorization on the Cards
Insurance verification and authorization is the first and probably most important step in the medical billing process. Patient eligibility verification involves checking out the patient’s coverage before services are provided. While checking patients’ insurance...
Clarifications on Reporting Non-urgent Services in the Emergency Department
Emergency department (ED) visits identified by CPT code 99285 require three key components: comprehensive history, comprehensive examination, and medical decision making of moderate complexity. However, a large proportion of all emergency department (ED) visits are...